Starting HAART at CD4 Count Less Than 200 Leads to Faster Disease Progression

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NEW YORK (Reuters Health) Dec 31 - Long-term follow-up shows that

highly active antiretroviral therapy (HAART) should be initiated in

HIV-infected patients before the CD4+ lymphocyte count drops below

200 cells/L.

Even with robust virologic suppression, risk of disease progression

is higher when treatment is started at this level rather than at

higher CD4 counts, Dr. R. Sterling at the Vanderbilt

University Medical Center in Nashville, Tennessee, and colleagues

report in the December 1 issue of the Journal of Infectious Diseases.

The team notes that according to current guidelines, highly active

antiretroviral therapy should be initiated in asymptomatic patients

when the CD4+ lymphocyte count is less than 200 cells/L. But, they

point out, these recommendations are based on observational studies

with median follow-up periods of up to 29 months.

In the study reported this month, the median follow-up was 36

months, with a quarter of the patients followed for at least 54

months and at least one individual followed for 75 months.

The researchers analyzed the development of new opportunistic

infection or death in 1173 patients after they began HAART. For

their analysis, the researchers divided patients in whom virologic

suppression was achieved into subgroups according to their baseline

CD4+ lymphocyte counts.

According to the article, patients with baseline counts of less than

200 cells/L had faster disease progression than those with baseline

counts of 201-350 cells/L or those with more than 350 cells/L at

baseline. There was, however, no difference in disease progression

between patients with baseline counts of 201-350 cells/L and those

with baseline counts above 350 cells/L.

" Our study helps to clarify when HAART should be initiated in

asymptomatic patients, " the authors conclude. " It is clear that

disease progression is slower when therapy is initiated at CD4+

lymphocyte counts of > 200 cells/L. "

J Infect Dis 2003;188:1659-1665